Mrs Dalia V Nield FRCS(Ed)   FRCS(Eng)

PROCEDURES: Breast Reduction

Introduction

Breast Reduction is indicated to reduce the size of large breasts and improve their shape.

Large, pendulous breasts are uncomfortable and can make a woman feel very self-conscious. They limit clothing and social and intimate activities. The weight of large breasts can also cause back pain, poor posture, skin irritation under the breasts and painful, markings of bra straps on the shoulders. Pregnancy can increase the size and weight of the breasts considerably.

There are many techniques for breast reduction and the resulting scars vary accordingly. There is always a scar around the nipple-areolar complex that is well camouflaged by the different colour of the areola and the surrounding skin. There is also a vertical scar running from the lowest central point of the areola to the fold under the breast and a transverse scar along the fold under the breast. The length of the scar in the fold varies with the size and shape of the breasts and the technique used to reduce them.

Preoperative

1 week

Postoperative

All scars are pink to start with and with time they became pale. The quality of the scars depends on your capacity to heal and the skill of your surgeon. Some people heal with thick unsatisfactory scars (keloids) and there are various treatments available to help this type of scarring.

Breast-feeding after breast reduction depends on the technique used, one tries to maintain continuity between the gland and the milk ducts but it is not possible to give 100 % guarantee that this will be preserved.

All breast tissue removed is analysed under the microscope to exclude breast cancer. Mammogram and self-examination are not affected.

There are many techniques to achieve a smaller well-shaped breast that will look natural and will suit your height, weight, rib cage or length of chest.

The final size of breast depends on your personal choice but the idea is to make you look natural.

You will be admitted to the London Clinic for a minimum of one night. The operation is performed under General Anaesthesia and I use drains that are usually removed the next morning. The operation time is 3 to 4 hours.

I tend to use, when possible, absorbable sutures under the skin that do not need to be removed. The dressing contains minimal padding and is fashioned with hypoallergenic microfoam. This we leave in place for 5 or 7 days.

Before your discharge I will measure you and advise on the new bra that you will need to bring with you to the first follow-up consultation.

The dressing is removed on your first post-op consultation and you go into a soft bra day and night for 2 weeks.

Before Surgery

The Operation

After Surgery

Complications of breast surgery

Infection is rare, but if it happens will result in slow healing, dressings and sometimes further surgery to improve the resulting scars. That is the reason for the careful pre-operative tests. During surgery and time in hospital you will receive antibiotic cover.

Bleeding with collection of blood (haematoma) can occur. I use drains and if there is too much drainage you may need to stay another night in hospital. This is rare.

Nipple sensation can be altered or lost; this is not common as the operation is designed to avoid nerve damage.

One of the worse and rare complications is nipple loss (necrosis); this is more likely in very pendulous breasts or in smokers. As a solution, your permission will be asked to detach the nipples and replace them as free grafts if during surgery the blood supply seems affected. This will be discussed before surgery. Nipple reconstruction can be carried out later if necessary.

Bad scarring and “dog ears” (irregularities at the end of scars) can be revised, usually after 3 months.

During your initial consultation we will give you relevant lists of possible complications.

Breast Reduction is one of the most successful operations in Plastic Surgery and has high patient satisfaction. In very young patients, further growth of the breast after pregnancy makes require further surgery.